4.N. Workshop: Maternal Oral Health Models and Initiatives in Global and Public Health Perspectives

Abstract   Achieving and maintaining good oral health is essential for both the oral and overall health of expecting mothers and the oral health of their young children. Dental caries can negatively affect daily activities, including eating, speaking, and social interaction. When expecting mothers have active dental caries, the risk for dental caries in these children becomes higher. Another common oral disease, periodontitis, was associated with systemic conditions, including cardiovascular disease, respiratory disease, diabetes, and potentially adverse birth outcomes. Some studies also showed the systemic impact of periodontal disease and the related pathogens that can lead to systemic inflammation and adverse birth outcomes, even though periodontal treatment has not been shown to improve birth outcomes. A mother's oral health status, her oral health knowledge, and beliefs also have been shown to significantly affect diet and home oral hygiene practice for young children. All the evidence suggests that pregnancy should be considered a critical period in which oral health education and dental care should be provided to improve the oral health of mothers and their young children. Despite the importance of a mother's oral health and their oral health knowledge in preventing dental caries in young children, maternal oral health is much neglected in primary and prenatal health discussions. This is even more significant in developing countries with inadequate oral health care infrastructure and workforce. In addition, with increased sugar consumption worldwide, oral disease prevention and oral health promotion are the keys to achieving oral health parity among the maternal and child population. This workshop aims to position maternal oral health as essential primary and perinatal health care and discuss the care models and initiatives in various contexts and geographical locations. At the care delivery and community-based interventions, Dr. Sophia will discuss her oral health education and tobacco cessation initiative for pregnant women in India. Dr. Irene will demonstrate her integrated oral health training model for midwives and dental providers in Indonesia. She will describe how her collaboration with the local government achieves collaborative training and care delivery to improve mothers and their spouses’ oral health and oral health knowledge in rural Indonesia. Dr. Jane will showcase her material oral health model for refugee and immigrant mothers in Switzerland. Lastly, Dr. Khabiso from South Africa will present how maternal oral health can be integrated at the national policy level through the collective efforts of public health organizations. Dr. Lee, the chair of this workshop, will provide a literature review on maternal oral health studies and how maternal oral health can be an essential part of primary and perinatal care and the WHO oral health initiative set for 2030. Key messages • Maternal oral health is essential in primary and perinatal health care discussion and a critical optic for global and public health agendas. • There are various maternal oral health programs and initiatives around the globe at care delivery level, community level, and policy level.


Background:
During the COVID-19 pandemic, most settings experienced healthcare service disruptions. The majority of cytological screening procedures were postponed to focus on assisting patients infected with COVID-19. In this study, we aimed to analyse the impact of the impact of the COVID-19 pandemic on the uptake of cervical cancer screening in Slovakia.

Methods:
Data on cytological screening procedures were obtained from two of the three health insurance companies in Slovakia for the years 2019 and 2020, covering the population of women aged 15 and older. All data were calculated stratified for age groups. Rates of cytological screenings were calculated as the number of procedures per women registered in the insurance company in the same age group and rate ratios were calculated as ratios of the rates for the years 2020 and 2019 for the same age group. Incidence rates were calculated as the number of newly diagnosed cervical cancer cases per women registered in the insurance company in the respective year.

Results:
Rate ratios of cytological screening procedures revealed that in both examined health insurance companies, the rate of cytological exams was lower in 2020 compared to 2019 (0.95 and 0.89). This was observed across all age groups. The results showed a clear and statistically significant age gradient, indicating that the level of disruption increased with age. The age group 60-69 years had the highest incidence rate of cervical cancer in 2019, at 54.3 per 100 000. In 2020, the highest rate was 48.3 in the age group 50-59 years. The lowest rates were in children and young adults (<20 years).

Conclusions:
This study confirms the significant impact of the pandemic on cervical cancer screening uptake in Slovakia, which may have delayed the diagnosis of cervical cancer into later stages of the disease with a worse prognosis. This may lead to increased mortality and years lived with disability due to this disease in Slovakia.

Key messages:
Disruptions in cervical cancer screenings were observed in Slovakia during the COVID-19 pandemic which may result in an increase in cervical cancer incidence and mortality. Strategies should be implemented to maintain cancer screening programs during health emergencies to avoid excessive mortality and morbidity. Achieving and maintaining good oral health is essential for both the oral and overall health of expecting mothers and the oral health of their young children. Dental caries can negatively affect daily activities, including eating, speaking, and social interaction. When expecting mothers have active dental caries, the risk for dental caries in these children becomes higher. Another common oral disease, periodontitis, was associated with systemic conditions, including cardiovascular disease, respiratory disease, diabetes, and potentially adverse birth outcomes. Some studies also showed the systemic impact of periodontal disease and the related pathogens that can lead to systemic inflammation and adverse birth outcomes, even though periodontal treatment has not been shown to improve birth outcomes. A mother's oral health status, her oral health knowledge, and beliefs also have been shown to significantly affect diet and home oral hygiene practice for young children.
All the evidence suggests that pregnancy should be considered a critical period in which oral health education and dental care should be provided to improve the oral health of mothers and their young children. Despite the importance of a mother's oral health and their oral health knowledge in preventing dental caries in young children, maternal oral health is much neglected in primary and prenatal health discussions. This is even more significant in developing countries with inadequate oral health care infrastructure and workforce. In addition, with increased sugar consumption worldwide, oral disease prevention and oral health promotion are the keys to achieving oral health parity among the maternal and child population. This workshop aims to position maternal oral health as essential primary and perinatal health care and discuss the care models and initiatives in various contexts and geographical locations. At the care delivery and community-based interventions, Dr. Sophia will discuss her oral health education and tobacco cessation initiative for pregnant women in India. Dr. Irene will demonstrate her integrated oral health training model for midwives and dental providers in Indonesia. She will describe how her collaboration with the local government achieves collaborative training and care delivery to improve mothers and their spouses' oral health and oral health knowledge in rural Indonesia. Dr. Jane will showcase her material oral health model for refugee and immigrant mothers in Switzerland. Lastly, Dr. Khabiso from South Africa will present how maternal oral health can be integrated at the national policy level through the collective efforts of public health organizations. Dr. Lee, the chair of this workshop, will provide a literature review on maternal oral health studies and how maternal oral health can be an essential part of primary and perinatal care and the WHO oral health initiative set for 2030.

Key messages:
Maternal oral health is essential in primary and perinatal health care discussion and a critical optic for global and public health agendas. There are various maternal oral health programs and initiatives around the globe at care delivery level, community level, and policy level.

Background:
Achieving and maintaining good oral health during pregnancy is essential for both the oral and overall health of expecting mothers and their young children. Dental caries can negatively affect daily activities including eating, speaking, and social interaction, and when expecting mothers have active dental caries, the risk for dental caries in these children becomes higher. Another common oral disease, periodontitis, was found to be associated with systemic conditions, including cardiovascular disease, respiratory disease, diabetes, and potentially adverse birth outcomes.

Importance:
Some studies also showed the systemic impact of periodontal disease and the related pathogens that can lead to systemic inflammation and adverse birth outcomes. A mother's oral health status, her oral health knowledge, and beliefs also have been shown to significantly affect diet and home oral hygiene practice among her children. Problem: Despite the importance of mother's oral health and oral health knowledge to prevent dental caries in young children, maternal oral health is much neglected in primary and prenatal health discussion. This is even more significant in developing countries where oral health care infrastructure and workforce are inadequate. With increase in sugar consumption growing worldwide with this lack of oral health care infrastructure, oral diseases prevention and oral health promotion are the key to achieve oral health parity among the maternal and child population.

Solution:
In this presentation, the author will discuss literature on maternal oral health and how to position oral health as an essential part of perinatal care along with WHO oral health initiative set for 2030. This is an introduction presentation for this workshop to set a stage and make a case why maternal oral health is a critical topic to discuss in global health and public health perspectives. Backgrounds and problem: By 2030, tobacco use is estimated to kill more than 8 million people worldwide annually, with LMICs accounting for over 80% of those deaths. In India, about 4.6% of women continue to use tobacco mainly (> 80%) in smokeless (SLT) form during pregnancy. This may lead to: higher risk of anemia ( 70%), hypertension, and postpartum hemorrhage; poor fetal development; and 2-3 times higher rate of low-birth and stillbirth babies. Importance: Anti-tobacco initiatives often focus on smoking over SLT, which is commonly consumed by women. Drivers of SLT use among women include: cultural appropriateness, medicinal benefits, and poor social determinants of health. These factors must be taken into account while formulating effective antitobacco interventions for pregnant women, ensuring safe motherhood and neonatal health.

Solution:
We propose integrating oral health interventions in mitigating tobacco use within the existing antenatal care (ANC) model. Women enrolled in public health facilities in an urban poor neighborhood in South India receive oral health education (OHE) integrated into ANC. The intervention promotes oral hygiene habits, dietary advices, improving dental healthcare utilization, and sensitization on the ill-effects of tobacco-use. Training for ANC providers focuses on delivering antenatal tobacco screening, cessation, and referral services. This includes expanding the medical history to record tobacco use, conduct oral examination and referrals to dentists and/or tobacco cessation centres. Final outcomes of OHE will be measured using pre and post KAP surveys informed by WHO Oral Health Surveys; and training programme using in-depth interviews among providers. Desired policy change is the inclusion of tobacco prevention and cessation programme in the Indian ANC guidelines.